Coronavirus infections in India have been hitting record peaks for the past few days and the death toll has been on the rise. But the official death count doesn't tell the full story, say experts.
At least 195,123 people have died and 17.3 million have been infected with the virus in India, according to official dataImage: Altaf Qadri/AP/dpa/picture alliance
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During the week between April 18 and 25, India reported 2.24 million new coronavirus cases, the highest number recorded by any country in a seven-day period. It also logged 16,257 deaths, almost double the 8,588 deaths recorded the previous week, according to Health Ministry data.
Altogether, 195,123 people have died while 17.3 million people have been infected with the virus in India.
These numbers are staggering, but experts and epidemiological modelers believe that the real number of COVID fatalities could be much higher than the deaths recorded by health departments nationwide.
"The distressing scenes of patients dying in ambulances and bodies burning on pyres outside crematoriums and even on pavements across cities and towns clearly show that the tragedy is far greater," Anoop Saraya, a private doctor, told DW.
'The true numbers are being suppressed'
India's relatively low fatality rate doesn't tell the whole story and suspicions abound that there's substantial undercounting in several states.
Suspected cases are not being added to the final count and deaths from the infection are being credited to underlying health conditions, point out observers.
"There appears to be a wide discrepancy between official records of deaths attributed to COVID-19 and reports of cremations and burials that are many multiples of what might normally have been expected," Gautam Menon, a professor of physics and biology at Ashoka University, told DW.
"These discrepancies suggest that the true numbers are being suppressed," the health expert said. "The actual number of deaths from COVID-19 may be 5 to 10 times the official numbers. Together with under-reporting of cases and the large test positivity ratios we are seeing across the country, the true scale of the pandemic may be far worse than the numbers would suggest."
Coronavirus wave batters India's health system
The coronavirus pandemic has hit India with full force. The already creaky health care system is buckling as a record surge in COVID-19 cases puts pressure on hospitals.
Image: Amit Dave/REUTERS
Unbearable loss
Relatives of a deceased COVID-19 patient grieve in front of a hospital in the Indian city of Ahmedabad. The health situation has spiraled out of control. The country recorded more than 333,000 new infections in the last 24 hours — the highest daily caseload in the world. That means more than 1 million people in India have been infected with the virus in the past four days alone.
Image: Amit Dave/REUTERS
Overcrowded hospitals
COVID-19 patients wait to be treated at this hospital in New Delhi. Many hospitals are completely overwhelmed. ""We are running desperately short of beds, desperately short of oxygen [and] essential medicines," Shuchin Bajaj, an Indian doctor and director of a hospital chain, told DW. "We are turning away patients. It's breaking our hearts. The situation in the country is almost apocalyptic."
Image: Danish Siddiqui/REUTERS
Waiting for hel
Many desperate patients still set out for hospital — and sometimes have to wait for hours in front of them, like this man in a motor rickshaw in Ahmedabad. At least he got one of the increasingly scarce oxygen cylinders. In Delhi alone, according to official figures, there is a shortage of around 5,000 intensive care beds, and some hospitals have almost run out of oxygen.
Image: AMIT DAVE/REUTERS
Clamor for oxygen
Many places across the country, like here in Allahabad, are seeing people crowd oxygen refilling stations with empty cylinders to bring their relatives. Oxygen is already being traded at exorbitant prices on the black market. The government is considering stopping operations at oil refineries and other industries that use oxygen for production so it can be provided to hospitals.
On Friday night, a fire broke out in this hospital near Mumbai. The entire intensive care unit burned down, killing at least 13 COVID-19 patients. The cause of the fire is still unclear. But dangerous fires often occur in India — even in hospitals. The cause is usually poor or outdated equipment. Fire protection is often inadequate and emergency exits are rare.
Image: AP/picture alliance
Non-stop cremations
Since the beginning of the pandemic, more than 186,000 Indians have died as a result of the coronavirus. Currently, the country is registering more than 2,000 deaths every day. In many parts of the country, such as here in the capital, Delhi, the crematoriums and cemeteries can barely keep up with the number of bodies.
Image: DANISH SIDDIQUI/REUTERS
'Double mutant' virus variant sparks concerns
Some experts say the situation in the country has worsened because of the rapid spread of a particularly contagious new "double mutant" variant of the coronavirus, B.1.617. It has prompted many countries to impose entry bans on travelers from India — and even issue travel warnings for the country. The United States has done that even for its citizens already vaccinated against the coronavirus.
Image: Xavier Galiana/AFP
Waiting for vaccines
India is home to more than 1.3 billion people. But less than 2 % of the adult population has been vaccinated so far. That's despite the country being one of the world's largest vaccine producers. But the order came late for Indian pharmaceutical companies to first meet domestic demand rather than exporting jabs. From May 1, vaccines will be available to all Indians over the age of 18.
Image: Amit Dave/REUTERS
Mass events fuel COVID-19 spike
Experts say it's not just the sluggish vaccination rate that is to blame for the rapid spread of the coronavirus in India. Religious, political and sporting events across the nation have also played a big role. The Kumbh Mela, India's largest Hindu pilgrimage festival, was attended by several million people. During the ritual bath in the Ganges, there were few signs of masks and social distancing.
Image: Money Sharma/AFP
Risky politics
Politics too has set a poor example so far. Regional elections were held in the state of West Bengal at the beginning of the month. There were mass rallies in the megacity of Kolkata during the campaign with leading politicians from the ruling BJP party. Prime Minister Narendra Modi also took part — and were celebrated by thousands of unmasked supporters.
Image: Kuntal Chakrabarty/IANS
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Surging cases lead to delayed results
Shahid Jameel, a virologist and director of the Trivedi School of Biosciences at Ashoka University, also maintains that the real death toll is higher than the recorded one, based on reports from cremations and burial sites.
He pointed out that the surging demand for COVID tests has created backlogs, causing labs that issued results within hours to now take days to deliver them.
"One problem that is happening is that test results are taking too long to come. It has happened to my cousin in Uttar Pradesh. He was tested on April 13 and his test result has still not come," Jameel told DW.
"And his will not be reported as a COVID death even though he had all symptoms, including a very high lung infection score and high inflammation markers in blood. There are thousands of cases like that."
COVID: India's health system under strain as virus crisis deepens
India's worsening coronavirus crisis is putting tremendous pressure on the nation's health infrastructure, with many states reporting a shortage of medical oxygen, treatment drugs and hospital beds.
The image shows relatives of a patient mourning outside a hospital in Ahmedabad city. India reported a record 234,692 cases of COVID-19 on Saturday. Experts say the harrowing trend of rising infections can be traced to two factors — extremely virulent mutations of the original virus, and the country's lax approach to restrictions on daily life to slow the spread of infection.
Image: Ajit Solanki/AP Photo/picture alliance
Shortage of oxygen
Several Indian states have reported a severe shortage of medical oxygen, while hospitals across the country are struggling to provide patients sufficient beds. On Sunday, Delhi's Chief Minister Arvind Kejriwal said that Delhi was facing an acute shortage of oxygen. India's Prime Minister Narendra Modi has asked state governments to source medical oxygen from industrial plants.
Image: Ajit Solanki/AP Photo/picture alliance
Crematoriums under pressure
Funeral centers are also struggling to dispose off the rising number of dead bodies and workers are working more than 14 hour shifts to handle the rising number of dead bodies. On Friday, Delhi reported 141 COVID-related deaths — the highest single day fatality count since the beginning of the pandemic.
Hospitals in most major cities are struggling to accommodate all COVID patients. In some places, reports suggest that patients with a severe form of COVID-19 are facing difficulties to secure an intensive care unit (ICU) bed. On Sunday, the Delhi government said that about 1,500 oxygen-equipped beds will be functional within a day or two at two sports complexes and a government school.
Amid the virus surge, state governments appealed for additional supplies of oxygen and treatment drugs. The federal government said special trains would transport oxygen tankers to needy states, and that oxygen use for industrial purposes would be limited. Meanwhile, the shortages are forcing some people to purchase critical drugs and oxygen from the black market.
In smaller towns like Surat, Kanpur and Ghaziabad, which have been reporting a high number of COVID deaths, mass cremations have been taking place in open spaces because of a dearth of crematorium space and deaths far exceeding official figures.
Although many countries have struggled to record the precise number of COVID deaths, in India, the problem has been compounded by the lack of an effective death registration system in many parts of the nation.
Most deaths in the country are not assigned a cause by a trained medical professional, making data on case fatality ratio unreliable.
"Because death registration is poor in India, the government will have little data to respond to the impact of COVID-19 on large sections of the population who live in rural areas," Jacob John, a renowned virologist, told DW.
Had these deaths been monitored through a registration system, they could have influenced the scale and geographic targeting of government relief measures as well as healthcare system responses.
"Unfortunately, we don't have a public health system at all in this country. The cause of deaths is seldom recorded," John said.
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Undercounting deaths outside hospitals?
In the absence of a reliable death registration system, the government's Integrated Disease Surveillance Program (IDSP) has been collecting data on COVID cases and deaths from testing laboratories and hospitals.
However, the IDSP's major drawback is that it has no way of tracking deaths outside hospitals.
"In the current scenario, India's soaring official COVID-19 count may just represent the tip of an iceberg. Because of low testing rates outside big cities, the actual caseload, and deaths, could be anything from 10 to 30 times higher," Vikas Bajpai of the Progressive Medicos and Scientists Forum told DW.
Positivity, too, has been high with nearly one in five in the country and one in three in Delhi who have been tested turning out COVID positive.
"Far better reporting of COVID-19 deaths is needed. Daily or weekly reporting of the total death counts by age and sex as well as by each municipality would help track if there is a spike in presumed COVID-19 deaths," Prabhat Jha of the Center for Global Health Research in Toronto told DW.
